December 12, 2015
Cholesterol contained in eggs caused eggs to receive a bad reputation in the past. Many in the medical profession felt eggs were too high in cholesterol to be part of a healthy food plan. Now the role of dietary cholesterol as it relates to a person's total blood cholesterol count now appears to be smaller than previously thought. Family history may have more influence on your cholesterol levels than how much dietary cholesterol is in your food. The bigger threat to your cholesterol levels is food that is high in trans fats according to the "experts."
I can imagine some of you almost choked when A.J and I said we consumed 12 eggs per week and sometimes more. The “experts” still recommend that a person with diabetes should not consume more than 200 mg of cholesterol each day. People that do not have diabetes may consume about 300 mg per day. One large egg has about 186 mg of cholesterol, which does not leave much room for other dietary cholesterol once that egg is eaten.
The “experts” claim that research suggests that high levels of egg consumption may (this is the key word) raise the risk of developing type 2 diabetes and heart disease. While the connection isn’t clear, researchers believe that excessive cholesterol intake, when it comes from animal foods, may increase those risks.
Because I already have diabetes, I basically ignore the statement, “Since all of the cholesterol is in the yolk, you can eat egg whites without worrying about how they’re affecting your daily consumption of cholesterol.” Many restaurants offer egg white alternatives to whole eggs in their dishes. You can also buy cholesterol-free egg substitutes in the stores that are made with egg whites.
Keep in mind that you need to whole egg to get the advantage of a complete protein. The yolk is also the exclusive home of some key egg nutrients. Almost all the vitamin A in an egg, for instance, resides in the yolk. The same is true for most of the choline, omega-3s, and calcium in an egg
I admit that I do not agree with the ADA when they want to limit egg consumption to three eggs per week. Nor do I agree with consuming only egg whites and missing the important nutrients in the egg yolk.
I admit that I like to consume eggs in the various ways, fried, poached, scrambled, salad, and in many other dishes. The ADA claims that eggs are less healthy when fried in butter or olive oil, but I can agree that you should not use vegetable oils. I am also contrary to the ADA because I like my sausage and my high fat bacon.
A hard-boiled egg can be a handy high-protein snack if you have diabetes. The protein will help keep you full without affecting your blood sugar. Protein not only slows digestion, it also slows glucose absorption, which is very helpful if you have diabetes. Having protein at every meal and for the occasional snack is a smart step for anyone with diabetes. However, they make the last statement and also do not want you to consume more than three eggs per week. Somewhere they need to be more consistent in their recommendations.
December 11, 2015
I almost ignored this article about ADA saying that eggs were good for people with diabetes. If it had not been for A.J, I might have passed on this. When A.J asked me about my thoughts on the article, I had forgotten about it already. A.J said he had also skipped over this the first time as he had just come from an appointment with the heart doctor and had been told not to eat eggs because of the cholesterol they contained. He said he had just nodded and forgot about the advice as his levels for cholesterol were very good and he could not figure out why he was being lectured about cholesterol.
A.J said he had been eating about twelve eggs per week and occasionally a few more when he wanted more protein. I agreed that I ate about the same number of eggs and had a hard time understanding why some doctors were still pushing no eggs because of the cholesterol. A.J asked me to read the article and then blog about it.
The American Diabetes Association considers eggs an excellent choice for people with diabetes. One large egg contains about half a gram of carbohydrates and this will not cause a spike in your blood glucose level. Many people with and without diabetes are afraid of eggs because one large egg contains nearly 200 mg of cholesterol. This is what drives many doctors to discourage eggs, but much of the evidence is still in favor of the egg and while highly debatable by doctors, many in our support group have great lipid panels and have no worry about cholesterol.
Monitoring your cholesterol is important if you have diabetes because diabetes is a risk factor for cardiovascular disease. High levels of cholesterol in the bloodstream also raises the risk of developing cardiovascular disease. Therefore, it is important for anyone with diabetes to be aware of and minimize other heart disease risks.
There are many benefits that people don't know about eggs. A whole egg contains about 7 grams of protein (a complete protein). Eggs are an excellent source of potassium and we need potassium for nerve and muscle health. This also helps balance sodium levels in the body as well, which improves your cardiovascular health.
Eggs have many nutrients, such as lutein, which protects you against disease, and choline, which is thought to improve brain health. Egg yolks contain biotin, which is important for healthy hair, skin, and nails, as well as insulin production. Eggs from chickens that roam on pastures will be high in omega-3s, which are beneficial fats for diabetics.
Eggs are easy on the waistline, too. One large egg has only about 75 calories and 5 grams of fat, only 1.6 grams of which are saturated fat. Eggs are versatile and can be prepared in different ways to suit your tastes. You can make an already-healthy food even better by mixing in tomatoes, spinach, or other vegetables.
December 10, 2015
This is continued from the previous blog.
#6. You think the glass is half empty. Do you allow negative self-talk to sabotage your healthy behaviors? Degenerative language can keep you in a negative space about your progress and achievements. When it comes to working out, California-based personal trainer Jenny Schatzle says you may have thoughts like, “I should have run faster” or “The person next to me looks better” or “I still have much more weight to lose.” Negative thoughts demotivate people from moving forward towards health that is more positive. “It doesn’t matter how fast or slow you go, you’re still lapping the person sitting on the couch. Be present and proud that you’re doing it at all.”
#7. You don’t think you’re good enough. Low self-esteem can instill a sense of feeling unworthy, that you don’t really deserve the benefits you’ve worked for diligently. This can prevent you from trying your hardest because if you hold a little something back, you can always say, “Well, I could have succeeded, but it cost too much or I had other priorities.” While this can help you save face, recognize that it’s not a genuine effort.
#8. You succumb to your self-destructive habits. Most of us have at least one. It might be tobacco, alcohol, or even ice cream. Whatever the habit, realize that habits are resistant to change. It takes perseverance, discipline and a good plan.
#9. You stop when you start seeing results. Many people can set goals and begin to see some progress as they work towards them. But don’t think you’ve made it just because you’re losing weight or building muscle tone. You need to maintain the discipline and keep it going. The Transtheoretical Model of behavior change says to really develop a long-lasting behavior, you need to maintain it for at least 6 months. Some people start seeing results and begin slowing down, stopping the very behavior that got them there in the first place.
#10. You expect the “old you” will reappear. In a bizarre twist, expecting the worst is a form of self-preservation. Even though we might be succeeding fabulously on our new workout or weight loss plan, because we are creatures of comfort, it’s somehow easier if we revert to our old selves. It’s like an old comfortable shoe.
I have been guilty of some of these, but I am not proud of letting these happen. I do see many other people with diabetes that continue to use many of these to sabotage their diabetes management. The sad thing is that they don't even realize they are sabotaging their management. I would like to say that we are all human, but that would be a cop out.
December 9, 2015
Have you stopped doing what you know is the right thing to do? Have you fallen off the wagon and can't get back on track? What causes us to do these things? I have previously written about self-sabotage of maintaining our good diabetes habits and it may be time to cover this topic again. I have received several emails lately that lead me to this, even though I have answered the emails.
In my previous blog, I covered only four points, but this time I will expand to 10 points.
#1. You’re stuck on auto-pilot. Despite the best of intentions, it’s hard to break out of that comfortable routine to which we’ve become accustomed. Get home from work, eat dinner and slide right into that easy chair. We have become a product of our own conditioning.
#2. You blame your responsibilities. One of the more common ways we sabotage ourselves is by not taking responsibility for our own lives. The reasoning goes something like this. “I don’t have time for exercise because I have to take care of my children/spouse/elderly parent/grandchild.” We all have responsibilities and it’s easy to subconsciously use them as excuses not to go after our dreams, because if we do, we may fail. Remember, doing something is better than doing nothing.
#3. You procrastinate. Another common form of self-sabotage is putting things off. A popular tactic of perfectionists. “Perfectionism leads to procrastination which leads to paralysis,” says Paul Coleman, author of the book, “Finding Peace When Your Heart is in Pieces.” It’s easy to be caught up in minutia and lose time. You can also over think things and spend all your time planning and none of it doing. Please realize it’s better to be done than perfect.
#4. You set unrealistic goals. Sure, it would make a huge difference if you worked out 2 hours a day. But, that’s not likely to happen. So why set a goal that is impossible to achieve? Then you waste time and energy dealing with the guilt that follows. Instead of setting lofty, unrealistic goals, be honest with yourself and come up with a plan you can adhere to and accomplish.
#5. Your friends and family undermine your lifestyle. Who in your social circle seems to get you regularly off the healthy track? You want to eat healthy but your friend talks you into going for pizza. While all relationships are unique, it’s worth examining how you feel after spending time with people. Are you getting an equal share of the relationship? If not, is it because you’re allowing your needs to become subservient to theirs? Perhaps you need to let it be known that you’re on a quest for a healthy lifestyle and ask them if they want to come along for the ride. You might just be surprised by their answer.
I will give the last five points in the next blog.
December 8, 2015
A 'Thank You' goes out to David Mendosa for his blog on December 3, which gave me a start for my own blog about people with type 2 diabetes giving insulin a fair consideration. Too many refuse to even consider insulin and as a result do not effectively manage their diabetes.
Yes, too many people with type 2 diabetes never consider insulin as the first line of treatment, but only as the last line of diabetes treatment when all else fails. The sad part of this is that they are encouraged by doctors to only use oral medications with many unpleasant side effects.
Many people with type 2 diabetes are not willing to give up their poor eating habits and as a result, the oral medications are not able to manage diabetes. Diabetes then becomes progressive and steadily becomes worse. The doctors keep adding one oral medication after another to help manage diabetes – to no avail. It is what the doctors want because they have an unhealthy fear of insulin causing a low (hypoglycemia).
That is the reason doctors keep changing and/or stacking one oral medication on top of another. They even use the threat of insulin to get you to change your eating habits and manage your diabetes more effectively. But, you are so afraid of insulin that you will not even consider it. For some it could be the fear of needles and for others it is the desire to stay on pills. For others, the insulin myths have a huge effect in scaring them away from great diabetes management.
David has some good questions to ask your doctor about insulin and I agree with most of them. The last two may get negative responses from your insurance company, Medicare will not authorize number six in his list, and even people with type 1 are denied access when they should have CGMs.
If you are a person newly diagnosed, be aware that most endocrinologists will work with you on insulin and often will prescribe insulin to help you manage diabetes effectively to give your pancreas time to recover from the strain you have given it before diagnosis.
Know that by using a low carb/high fat meal plan is also good for you and will make diabetes easier to manage and will not require a lot of insulin. I have written about making insulin the first choice for treatment of type 2 diabetes. I have also written about what to do when first diagnosed.
December 7, 2015
The FDA said Friday December 4, that SGLT2 (sodium-glucose cotransporter-2) inhibitors such as empagliflozin (Jardiance), dapagliflozin (Farxiga), and canagliflozin (Invokana) will need new warnings on the risks of ketoacidosis, urinary tract infections, and other serious illnesses.
The FDA communication stated that there have been more than 70 cases of ketoacidosis reported to the agency. The also listed 19 “life-threatening” cases of urosepsis (septic poisoning from retained and absorbed urinary substances) and pyelonephritis (inflammation of the kidney and its pelvis, caused by a bacterial infection).
The 19 cases of serious urinary tract infections occurred only in patients treated with canagliflozin or dapagliflozin; although the FDA stopped short of saying that empagliflozin was free of such risk. Although none were fatal, four patients needed intensive care treatment and all were hospitalized. No data were available on patients’ prior history of urinary infections, and the review did not identify other factors that might predispose patients to such infections.
Review of the adverse event reports disclosed that the median time between the start of SGLT2 inhibitor therapy and onset of ketoacidosis was 43 days (range 1 day to 1 year). The drug dose did not seem to be related to the risk of ketoacidosis, the agency said.
The review did identify some other potential risk factors. These included:
- Low carbohydrate diet or reduction in overall caloric intake
- Reduction or discontinuation of insulin therapy
- Discontinuing an oral insulin secretagogue
- Alcohol use
The FDA recommended that physicians consider these risk factors before prescribing SGLT2 inhibitors and that patients taking these agents and complaining of symptoms consistent with ketoacidosis be formally evaluated. The agency also said that the drugs should be stopped if ketoacidosis is suspected.
And, when patients on these drugs have risk factors known to increase risk of ketoacidosis, such as prolonged fasting because of surgery or acute illness, clinicians should consider monitoring the patients closely or stopping the drugs altogether.
I had wondered how long it would be before this happened and how many more events have to happen before the drugs have more limited use.
December 6, 2015
Suneel Dhand, MD has become a regular at complaining about the use of providers in referring to doctors. With all the terms that doctors invent for their lack of communications with patients and the terms they hang on patients, the term providers fits quite well. This is the third blog by him, complaining about the term “provider.”
Dear Suneel Dhand, MD,
I don't think your complaining about the term “provider” is justified. Doctors label patients everyday and many show us disrespect everyday.
- They talk at us instead of with us.
- They use other terms to label communication with patient, such as – patient engagement and many wanted extra money to do this.
- They try to put labels on us – consumers – and this continues even today.
- Many label us as non-compliant and other names, mainly because they don't communicate.
- Many bully patients, especially the elderly.
- Many make assumptions about patients and cause harm.
- Many hand patients a fist full of prescription without any explanations.
I could go on, but you get the idea. Until doctors use communication with patients and learn what Dr. Rob Lamberts has to say about communications, “Communication isn’t important to health care, communication is health care.” (Bold is my emphasis), many doctors will not get the respect they deserve and the media and patients will continue to use the term providers. And, don't forget that most in the media become patients and don't like the disrespect you show them. Remember, Suneel Dhand, MD that respect flows both ways.
The pedestal that you try to build for yourself can be broken when you complain too much without examining what you are doing to patients. In addition, many providers supported state medical boards that tried to limit things that you dislike and were afraid might show us what can be done.
I can agree that when you are lumped together with others supporting professions, (no, I did not say professionals as most are very unprofessional), this is not a good thing and some writers carry this to the extreme.
Until you earn the respect of your patients and others on electronic media, the term may continue to haunt you. Dr. Rob Lamberts has earned the respect of many people, as many other doctors have and when referring to them, I will continue to use the correct title. Complainers and whiners will continue being referred to as providers.
Bob Fenton, patient and blog owner